Revised and approved by the ACEP Board of Directors April 2008
Reaffirmed by the ACEP Board of Directors October 2001
Revised and approved by the ACEP Board of Directors January 1997
Originally approved by the ACEP Board of Directors March 1992

Emergency physicians should recognize children's physical and emotional reactions to painful or frightening procedures and be prepared to offer multiple forms of supplemental care (ie, visual imagery, distraction, analgesia, and sedation) to improve cooperation through appropriate management of each patient's fear, discomfort, and anxiety.

Any child with significant pain should receive appropriate and adequate analgesics, including the use of local infiltrative and/or topical anesthetics when feasible. Sedation, the controlled lessening of a patient's awareness of the environment and pain perception while maintaining stable vital signs, independent airway, and adequate spontaneous respirations, should be used whenever safely possible.

To promote the safe use of sedation and analgesia, the American College of Emergency Physicians recommends the following:

• Consider the relative safety and appropriate use of non-pharmaceutical modalities such as distraction and visual imagery alone or in conjunction with pharmaceutical agents such as sedatives and analgesics.
  
  
• Physical restraint to prevent non-pain and non-fear related inadvertent movement may be needed as an adjunct after adequate sedation and analgesia; however, physical restraint should not be used as a first line technique to prevent movement due to pain- or fear-generated active withdrawal: to do so may alter the perception of physical restraint from one of caring to one of hostility. This is not consistent with child friendly care and may lead to long term fears of physicians and medical care providers in general.
  
  
• The decision to employ sedation or analgesia and the selection of a specific technique should be individualized for each patient by the physician and not be required or restricted for specific diagnoses.
  
  
• Emergency physicians and the staff assisting them must be familiar with the pharmaceutical agents they employ and be prepared to manage their potential complications.
  
  
• Department guidelines related to the use of sedation and analgesia should address preparation for sedation including evidence based NPO guidelines, monitoring, staffing, equipment, consent, discharge instructions, and continuous quality improvement.
  
  
• Distraction, sedation, and analgesia constitute a significant aspect of emergency department pediatric care. Used with appropriate safeguards, these procedures are offered by emergency physicians to children under their care to improve not only their physical and emotional experience during the current visit but their future health care experiences as well.